| NPI | 1730382722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9610) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL D5604) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 48664) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2023-01-12 |